Definition

Pancreatitis in children, as in adults, occurs when the pancreas becomes swollen and inflamed.

Causes

The pancreas is an organ behind the stomach.

It produces chemicals called enzymes, which are needed to digest food. Most of the time, the enzymes are only active after they reach the small intestine.

When these enzymes become active inside the pancreas, they digest the tissue of the pancreas. This causes swelling, bleeding and damage to the organ and its blood vessels. This condition is called pancreatitis.

Common causes of pancreatitis in children include:

• Trauma to the belly, such as from a bicycle handlebar injury
• Blocked bile duct
• Side effects of medicine, such as anti-seizure medicines, chemotherapy, or some antibiotics
• Viral infections, including mumps and coxsackie B
• High blood levels of a fat in the blood, called triglycerides

Other causes include:

• After an organ or bone marrow transplant
• Cystic fibrosis
• Crohn disease and other disorders, when the body's immune system attacks and destroys healthy body tissue by mistake
• Type 1 diabetes that is uncontrolled
• Overactive parathyroid gland
• Kawasaki disease

Sometimes, the cause is unknown.

Symptoms

The main symptom of pancreatitis in children is severe pain in the upper abdomen. Sometimes the pain may spread to the back, lower abdomen, and front part of the chest. The pain may increase after meals.

Other symptoms may include:

• Cough
• Nausea and vomiting
• Swelling in the abdomen
• Fever
• Yellowing of the skin, called jaundice
• Loss of appetite
• Increased pulse

Exams and Tests

Your child's health care provider will do a physical exam, which may show:

• Abdominal tenderness or lump (mass)
• Fever
• Low blood pressure
• Fast heart rate
• Fast breathing rate

The provider will perform lab tests to check the release of pancreatic enzymes. These include tests to check the:

• Blood amylase level
• Blood lipase level
• Urine amylase level

Other blood tests include:

• Complete blood count (CBC)
• Panel or group of blood tests that provide an overall picture of your body's chemical balance

Imaging tests that can show inflammation of the pancreas include:

• Ultrasound of the abdomen (most common)
• CT scan of the abdomen
• MRI of the abdomen
  

Treatment

Treatment may require a stay in the hospital. It may involve:

• Pain medicines
• Stopping food or fluids by mouth
• Fluids given through a vein (IV)
• Anti-nausea medicines for nausea and vomiting
• Low-fat diet

The provider may insert a tube through the child's nose or mouth to remove contents of the stomach. The tube will be left in for one or more days. This may be done if vomiting and severe pain don't improve. The child also may be given food through a vein (IV) or a feeding tube.

The child can be given solid food once they stop vomiting. Most children are able to take solid food within 1 or 2 days after an attack of acute pancreatitis.

In some cases, therapy is needed to:

• Drain fluid that has collected in or around the pancreas
• Remove gallstones
• Relieve blockages of the pancreatic duct

Outlook (Prognosis)

Most cases go away in a week. Children usually recover completely.

Chronic pancreatitis is rarely seen in children. When it occurs, it is most often due to genetic defects or birth defects of the pancreas or biliary ducts.

Possible Complications

Severe irritation of the pancreas, and pancreatitis due to blunt trauma, such as from a bike handle bar, can cause complications. These may include:

• Collection of fluid around the pancreas
• Buildup of fluid in the abdomen (ascites)

When to Contact a Medical Professional

Call the provider if your child shows symptoms of pancreatitis. Also call if your child has these symptoms:

• Intense, constant abdominal pain
• Develops other symptoms of acute pancreatitis
• Severe upper abdominal pain and vomiting

Prevention

Most of the time, there is no way to prevent pancreatitis.

References

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Pancreatitis. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 378.

Schaffzin JK. Acute pancreatitis. In: Long SS, ed. Principles and Practice of Pediatric Infectious Diseases. 6th ed. Philadelphia, PA: Elsevier; 2023:chap 62.

Vitale DS, Abu-El-Haija M. Pancreatitis. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 82.